Can a stingray tear a tendon? A case report of delayed Achilles rupture following envenomation

Stingray injuries, though common in coastal regions, rarely result in severe musculoskeletal complications such as tendon rupture. This case report presents the first documented instance of a 61-year-old male who sustained a stingray injury to the Achilles tendon, initially masked by a concurrent infection, leading to a delayed diagnosis and surgical repair. The patient presented to urgent care 5 days postinjury with pain, erythema, and chills, and was treated for a soft-tissue infection. Persistent symptoms prompted a referral to the emergency department (ED), where magnetic resonance imaging revealed a complete Achilles tendon rupture with associated infection. Surgical repair was delayed until the infection resolved, and a V-Y gastrocnemius advancement was performed 9 weeks postinjury. The patient achieved full recovery at 1-year follow-up. This case underscores the importance of a high index of suspicion for musculoskeletal injuries in marine trauma, the role of advanced imaging in the ED, and the need for interdisciplinary management to prevent long-term complications. Emergency physicians must consider tendon injuries in patients with persistent symptoms following stingray envenomation, ensuring timely diagnosis and treatment to optimize outcomes.